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Morning Headlines 8/28/19

August 27, 2019 Headlines No Comments

WebPT Announces Significant Investment from Warburg Pincus

Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT from Battery Ventures.

JLL Partners And Water Street Acquire THREAD

A PE firm and a strategic investment firm acquire Thread, which offers virtual clinical trials tools such as electronic consent, telehealth, sensor integration, surveys, and patient authentication and engagement.

2019 Black Book Advisory Survey: Bluetree Network Earns Top Strategy, Implementation & Support Consultants Rating Among Epic Systems Users

Black Book names Bluetree Network #1 among 33 Epic consulting firms.

News 8/28/19

August 27, 2019 News 5 Comments

Top News

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Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT from Battery Ventures.

Co-founder and President Heidi Jannenga, PT, DPT will move to chief clinical officer, while industry long-timer Nancy Ham remains as CEO.

Other Warburg Pincus health IT investments include Intelligent Medical Objects, Experity Health, and Modernizing Medicine.


Reader Comments

From Snark Week: “Re: rumors and snark. Less, please – this is a news site.” Not to nitpick, but HIStalk is whatever I want it to be. Things I’ve learned in doing it for 16 years: (a) everybody loves rumor and humor except when it’s about their company, then they get all high and mighty about journalistic integrity; (b) nobody reads sites that just vomit up dull, inexpertly reported straight news; and (c) everybody thinks their opinion as a reader is representative and therefore their sometimes-cranky recommendations are by definition unerringly correct. I write HIStalk for myself, but everyone is welcome to read it with me.


HIStalk Announcements and Requests

Which would you hate missing most: (a) Epic’s UGM, or (b) the HIMSS conference?


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Hound Labs, which is working on the first marijuana breathalyzer (the device also measures alcohol levels), raises $30 million, increasing its total to $65 million. Fun facts: “Law and Order” creator Dick Wolf is an investor in the company, which was founded by former deputy sheriff, SWAT team member, ED doctor, venture capitalist, and White House fellow Mike Lynn and his wife Jenny, who was a marketing executive and also a White House fellow.

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A PE firm and a strategic investment firm acquire Thread, which offers virtual clinical trials tools such as electronic consent, telehealth, sensor integration, surveys, and patient authentication and engagement. Former US Army paratrooper Jeff Frazier founded the company as Definitive Media in 2005.

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PeerWell — whose digital health platform addresses workers’ compensation surgery issues such as pain management, surgery avoidance, surgery optimization, and recovery — raises $6.5 million in a Series A funding round.


Sales

  • Lehigh Valley Health Network chooses IKS Health’s Scribble for asynchronous virtual scribing.

People

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Apervita hires Kevin Hutchinson (MyTaskit) as CEO.

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Ontario Systems promotes Jason Harrington to CEO, where he will replace retiring co-founder and CEO Ron Fauquher. New Mountain Capital acquired a majority share of the company last week.


Announcements and Implementations

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A new KLAS report on computer-assisted coding finds that 94% of customers would buy their existing product again. 3M and Optum showed improved satisfaction in the past three years, while Dolbey is most consistent at driving outcomes. Up-and-comer EzDI earns good marks for support, but half of respondents report problems with EHR integration.

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Black Book names Bluetree Network #1 among 33 Epic consulting firms. More than half of survey respondents say they will increase their consultant-led engagements in 2020 based on needs such as EHR optimization, analytics, revenue cycle transformation, and IT managed services.

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Epic celebrates #UGM19 (notably, the first year it has endorsed a conference hashtag) with its top 10 most-read customer successes on Epic.com so far in 2019. Among them:

  • Henry Ford’s ED triage protocol that identifies possible human trafficking victims.
  • MyChart price estimates.
  • Mackenzie Health’s patient check-in via MyChart and kiosks.
  • Mona Hanna-Attisha, MD’s use of Epic to discover of Flint, Michigan’s water crisis.
  • Nebraska Medicine’s standardized hand-off.
  • University of Utah Health’s neonatal weight gain program.
  • Piedmont Healthcare’s work on hospital-acquired infections.
  • Centura Health’s OR supply program.
  • Epic’s Happy Together unified, patient-centered view of MyChart.
  • Cambridge University Hospitals NHS Trust’s atrial fibrillation screening.

Baptist Health South Florida goes live on Kyruus ProviderMatch for Consumers as well as the Spanish language version, allowing consumers to search for providers and schedule appointments from its website.


Other

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An @EricTopol find: researchers find that AI can accurately predict age and sex from ECGs. The value of this study isn’t related to sex – it’s that ECGs are now known to contain information that we humans don’t fully understand that might be useful in diagnosis.

Hat tip to @Cascadia, who noticed an EHR integration manager job posting from BCBS insurer Premera. Its analytics team will use InterSytems HealthShare to review EHR and claims data for “enabling the translation of real-time clinical data from medical service providers into data models and dashboards in support of data science” to improve outcomes and reduce cost.

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A Japan-based business unit of contract research organization PPD (Pharmaceutical Product Development) will offer research services to clients in Japan, including development of EHR-enabled clinical trials. North Carolina-based PPD, started by pharmacist Fred Eshelman, PharmD in 1985 as a one-person consulting firm, was sold to an asset management company and a private equity firm in 2011 for $3.9 billion. It has since grown from 1,500 employees to 21,000, with offices in 48 countries. It recapitalized in 2017 with investment by the governments of Abu Dhabi and Singapore, valuing the company at $9 billion. Eshelman also started Furiex Pharmaceuticals, sold in 2014 to another drug company for $1.1 billion. Eshelman has donated at least $140 million to his alma mater, University of North Carolina’s School of Pharmacy, now named after him.

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A dermatologist’s op-ed piece in the Philadelphia newspaper observes that even with interconnected EHRs, doctors don’t usually know how their patients are doing or even when they have died. He was going through his patient list when an EHR pop-up told him that one of them had passed away six months before, making him sorry that he had missed the chance to console the family or even to send a card, but then wondered whether the family members, who he had never met, would find that appropriate anyway.  

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Clickbait headline of the day, from Forbes. The story is about a hospital in Egypt (not Oracle itself) that is using Oracle ERP, analytics, and workforce management for purely business functions. I’m sure the hospital will let us know when their payroll package cures cancer.


Sponsor Updates

  • Contract therapy EHR vendor Casamba chooses NVoq as its preferred speech recognition provider.
  • Dresner Advisory Services names Dimensional Insight an Overall Leader in its 2019 Industry Excellence Awards.
  • Williamson Memorial Hospital implements paperless registration using Access EForms following its go-live on Meditech as a Service.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.


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Morning Headlines 8/27/19

August 26, 2019 Headlines No Comments

Visibly (formerly Opternative) recalls online vision test

Facing pressure from the American Optometric Association and the FDA, Visibly recalls its online vision screening test over lack of FDA marketing approval, and concerns with safety and efficacy.

HHS Proposes 42 CFR Part 2 Reforms to Increase Coordinated Care, Reduce Provider Burden, and Improve Substance Use Disorder Treatment

HHS publishes a proposed rule that will give providers greater access to the medical records of patients seeking treatment for addiction while ensuring privacy guardrails stay in place.

ACT Health opens tender for digital health record with full EMR and PAS capabilities

The Australian Capital Territory Health Directorate wants to replace its patient administration system with a new EHR that has helped other health systems achieve HIMSS Stage 7 EMRAM.

Curbside Consult with Dr. Jayne 8/26/19

August 26, 2019 Dr. Jayne 3 Comments

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I’ve received several post cards and also emails from Nuance lately, marketing their Ambient Clinical Intelligence product which they also describe as “the exam room of the future.” I’m pretty sure this is the follow-on to what many of us saw in their demo/theater at HIMSS.

The premise was this: the physician and patient interact in an exam room that supports speech recognition while also serving up EHR data to the provider upon request. The demo scenario was a 40-something woman with knee pain. The system helped the provider navigate to find information about previous visits as well as documenting the current one.

At the time, I spoke with some of the Nuance team and it sounded like they were really focusing on subspecialty situations where the workflows would be fairly standardized and/or predictable. In order for the technology to work, there needs to be a significant repository of data available as far as medical dictionaries, codified discrete data, etc. Then on top, you have to layer the typical exam findings, questions, and possible answers for different conditions, to ensure the system will be able to recognize what is being said without having to “train” the speech recognition portion. Beyond that, components of EHR historical data t have to be served up to help answer questions the clinician might ask, such as when a medication was first prescribed, etc.

Although the orthopedic demo was pretty flashy, it was obvious that the participants were actors and that they were working from a script, especially when the real-time-looking demo on the screen didn’t 100% match what had been said. Still, it was attention-grabbing enough to send me to speak to one of their reps about where they really were in development for other specialties. It sounded like they were a bit of a way out for what would be necessary to support workflows in primary care or urgent care, which can be the exact opposite of predictable. With the mailings and email ads, I figured perhaps they had made more progress and decided to follow up.

One piece on the website that caught my eye was something they’re calling “integrated machine vision” and is designed to “detect non-verbal cues.” I’d be curious to learn more about how they’re doing this, and what it might entail to create a library of non-verbal information that could be parsed to add context to notes. I’m also curious whether this applies only to the patient side or whether it’s skilled enough to pick up non-verbal input from the clinician. Would it be able to interpret the complete absence of a poker face that I exhibited recently when seeing the largest hernia I have encountered in my career? Could it interpret the glassy-eyed stare of my patient to determine whether they just weren’t paying attention or whether I should be asking more deeply about potential substance abuse? For clinicians caring for teens, I’d think that ability to quantify teenage eye-rolling would be the gold standard.

Another major component of the system is the virtual assistant piece, kind of like Alexa, Siri, or Google. “Hey Dragon” is the wake word to access information in the EHR, and as this technology evolves, it gets us closer and closer to what many of us have seen in the “Star Trek” universe over the years. Having toyed with a virtual assistant over the last couple of years, I know there are nuances in how the questions are asked to get the data you want to get. Somehow in “Star Trek” they don’t have to ask the computer three different questions to get the desired output. I’m hoping Nuance has been able to figure out the secret sauce needed to translate how physicians think and speak and adapt the system to match.

I was also intrigued by their “intelligent translation and summarization” comments on the website, where they note that it “turns natural language into coherent sentences.” That sounds a bit like physicians might have trouble being coherent, which probably isn’t far off the mark for many of us, especially at the end of a particularly long and brutal shift. I know I lean heavily on my scribes (when I’m fortunate enough to have one) to translate my often-wordy home care instructions into a bulleted list that patients will be more likely to follow once they get home.

Although some of us are skeptical about the power of AI, I was intrigued by some of the numbers presented on the website. The company claims 400 million consumer voiceprints, with 600 million virtual and live chats per year powered by their AI technology. Although I’ve used speech recognition in the past, I didn’t realize the growth in speech-to-text and the fact that they have 125 voices in 50 languages. If they could somehow work with Garmin to integrate the “Australian English Ken” voice I used to have with my stand-alone GPS, I’d be sold. I could listen to him all day, even if he was continually telling me to make a U-turn at the next safe intersection.

This type of technology could really be a game-changer for physicians, perhaps reducing burnout, decreasing medical errors, and making visits more efficient for patients and clinicians alike. I’d be interested to hear from anyone who is actually employing these types of features in practice, whether it’s a comprehensive suite as Nuance is promoting or whether it’s freestanding elements such as a voice assistant for chart navigation, data retrieval assistance, or something else.

I wonder how much research is being done in this arena outside of the vendor space, whether any of the institutions that have strong informatics programs are getting involved with similar initiatives, or whether it’s so expensive that the work is typically vendor-driven.

From a patient perspective, I’d love to see a voice assistant functionality that could make it a reality for me to simply ask it to “make me an eye appointment after November 3 using one of the open slots on my calendar” and have it connect with my provider’s practice management system and get the job done without two phone calls, a patient portal message, and a two-week timeframe like it took me to make my last appointment. Now that would be something, indeed.

What is your most sought-after voice assistant functionality? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 8/26/19

August 25, 2019 Headlines No Comments

Health Catalyst Reports Second Quarter 2019 Results

Health Catalyst reports Q2 results: revenue up 60%, adjusted EBITDA –$5.7 million vs. –$8 million.

$16B veterans’ health project hits major snag

The VA’s $16 billion Cerner rollout at three medical centers will likely be delayed from March 2020 to until October 2020.

Privacy Incident at Massachusetts General Hospital’s Neurology Department

Massachusetts General Hospital notifies 10,000 people that their information, which was stored in the databases of two neurology research applications, was accessed by an unauthorized third party.

Monday Morning Update 8/26/19

August 25, 2019 News 17 Comments

Top News

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Health Catalyst reports Q2 results: revenue up 60%, adjusted EBITDA –$5.7 million vs. –$8 million.

HCAT shares dropped 10% Friday after the announcement, valuing the company at $1.4 billion. They remain 49% above their opening IPO price on July 25, about the same price as they closed on that first day of trading.

Health Catalyst expects to lose $30 million on $150 million in revenue in 2019.

From the earnings call:

  • The company expects annual revenue growth of over 20%.
  • Professional services will contribute a meaningful portion of revenue, with a gross margin of 35%.
  • Medicity’s flat to declining $25 million in annual revenue will slow overall company revenue growth, but continues to present cross-sell opportunities.
  • Health Catalyst says M&A opportunities will result from the more than 1,000 companies that offer clinical, financial, and operational analytics.

Reader Comments

From Suspicious Minds: “Re: health IT salespeople. I’m one. Why wouldn’t you trust me? I’m just doing my job as a professional.” I’ve worked with countless numbers of IT, health IT, drug, and medical device company reps over the years. I have “liked” many of them and “trusted” some of them a little, but I always remained on alert knowing that (a) I was outclassed by the psychology they were exquisitely trained to use to make the sale in whatever way was required; (b) the information they had been provided about my organization and me that gave them a rich palette of ways to push whatever of our hot buttons that seemed most promising; and (c) they were brainwashed into believing that whatever they were selling was the perfect solution to every problem, as they sometimes confidently touted an obviously inappropriate product fueled by the cult-like programming that had injected into their heads at sales meetings. They weren’t necessarily being dishonest — they were just well trained and richly compensated to push whatever they had on their shelves. They got to walk away to the next deal while their peers in implementation, tech, and support were stuck with contrasting the vision we had heard with the reality of what we were getting (and would be stuck with for years). Salespeople often say they’ll walk away if it’s not a good fit, but I think that’s situational depending on company and quota pressure, not to mention that you would hope that the prospect isn’t so clueless as to require strategic guidance from a sales rep in the first place.

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From Jubilant: “Re: AI in healthcare. Rags are saying its healthcare future isn’t rosy.” To be fair, those same rags rode the AI hype hard in pandering for clicks with ridiculous stories claiming just how rosy healthcare’s use of AI was going to be. Now that the clicks have moved on, suddenly they are the voice of reason in proclaiming AI’s benefit as questionable. It’s the same crappy journalism model in which some news site misinterprets a poorly researched article in saying that coffee is a health hazard, only to follow up with another article that says it’s healthy. News sites get clicks only to the extent they can convince you that something is new even when it isn’t. The people writing for health IT sites generally understand the Gartner Hype Cycle only well enough to milk writing about the problems of a given technology only after they’ve exhausted the possibilities of fawning over it.

From Minister of Mayhem: “Re: mobile apps. I’m looking for companies that offer an app that’s a mixture of patient portal, scheduling, and communications with providers that can also push out patient check-ins. Either specific to oncology or adaptable to it.” I will open the floor to readers, who can leave a comment (I’ll waive my usual requirement that no vendors be named).

From Pod People: “Re: podcasts. I’ll say again – you need to start one. More listeners than ever.” I wouldn’t want to be one of those many podcasters who (as I surmise, at least, since I don’t listen to podcasts) have little to say or don’t say it very well, often the same people who exhibit those qualities in written form. Simply reading HIStalk or doing interviews into a microphone wouldn’t add much value.

From Roy G. Biv: “Re: HIMSS. You should hire someone dress up like your Smokin’ Doc and have him walk around the hall.” That idea is undignified and inappropriate and thus perfect. Lorre says every year how entertained she is by lines of CEOs and other booth-visiting dignitaries waiting for their chance for a Smokin’ Doc selfie, complete with their fingers curled in comradeship over his two-dimensional shoulder. An in-person variant would certainly be bizarre, although probably not embraced (literally or figuratively) by the HIMSS Police.   


HIStalk Announcements and Requests

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Not too many poll respondents burst with pride when thinking about their largest local healthcare system. I’m not surprised – of my health system employers, I recognize their competence in certain areas, but have seen as an insider the warts that make their communities rightfully wary.

New poll to your right or here: What is your experience using Apple Health Records to view your health system’s EHR data? The poll choices are terse by necessity, but click the poll’s Comments after voting to say what you really mean.

Thanks to the companies that offered Lorre a HIMSS20 exhibit hall pass. We’re set.


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Sales

  • UC San Diego Health chooses Phynd to manage provider information, integrating with the Epic system it shares with UCI Health.
  • Sunset Community Health Center (AZ) will implement MyHealthDirect for centralized call center patient scheduling and patient self-scheduling.

Announcements and Implementations

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Israel-based healthcare data analytics vendor MDClone raises $26 million in a Series B funding round, increasing its total to $41 million. The company’s technology translates patient data into a synthetic equivalent in which the actual PHI has been removed, allowing anyone to access and analyze patient-level data without compromising patient privacy. It’s a great idea with an uncertain market given that data and EHR vendors are happily selling patient data even without such protection and nobody seems to much care. Founder and CEO Ziv Ofek founded DbMotion and sold it to Allscripts for $235 million in 2013, while the chief medical officer and VP of innovation are also DbMotion alumni.


Government and Politics

Politico reports that the VA’s $16 billion Cerner rollout at three medical centers will likely be delayed from March 2020 to until October 2020.

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The VA’s OIG investigates how quickly eight of its medical facilities scan paper documentation sent by external providers (including incoming faxes) into the patient’s electronic chart, concluding that the VA’s backlog is a five-mile tall pile of paper of 597,000 documents going back to October 2016. HIM departments didn’t always complete quality review before the scanned documents were dumped into the shred bin, eliminating the possibility of correcting errors. The problems are usual VA ones — poor oversight, lack of monitoring, and short staffing.


Privacy and Security

Massachusetts General Hospital notifies 10,000 people that their information, which was stored in the databases of two neurology research applications, was accessed by an unauthorized third party.


Other

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Celebrities and wealthy people in Iran are hiring private ambulance services as “a taxi service with a siren,” allowing them to avoid Tehran’s never-ending traffic gridlock by running red lights and passing stopped cars, with overwhelmed police departments doing little to discourage the practice. Ambulance companies say the annoyed locals are now refusing to make way for the ambulances to pass, assuming that “it’s a celebrity going to get a haircut” instead of a patient in with a life-threatening problem.

In Zimbabwe, hospital administrators warn their underpaid nurses to stop eating patient food and bringing in refreshments to sell room to room.

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Epic kicks off its 40th birthday this week with UGM, whose theme is “Summer of ‘79.” Spoilers: musically that year, there was a lot of disco, drek from Barbra Streisand and Kenny Rogers, and some pretty good ELO. Small-diagonal, high-depth tube TVs played real-time programs like “M*A*S*H,” “Taxi,” “The Love Boat,” and “Dallas.” Few people ignored real life by staring at their phones unless they were counting down the minutes until cheaper rates kicked in. Clothing choices from back then best remain unexplored. “The Partridge Family” unfortunately went off the air a few years before 1979, otherwise Epic could paint one of the gazillion attendee buses in its trippy pattern and everybody could sing out the windows at puzzled Veronesi.


Sponsor Updates

  • Loyale Healthcare publishes a new industry analysis, “Healthcare Costs Continue to Soar as Patients Look for a New Kind of Provider Relationship.”
  • MDLive SVP Michael Farrell will present at the Connected Health Summit August 27-29 in San Diego.
  • Meditech recaps why it is positioned for continued growth in the UK.
  • Stratus Video partners with Mobile Heartbeat to enable access to interpreters on provider smartphones.
  • Netsmart will exhibit at the TAHCH Annual Conference and Meeting August 27-29 in Grapevine, TX.
  • Relatient and Unlimited Systems partner to make patient engagement easier for oncologists and cancer patients.
  • Surescripts will exhibit at Epic UGM August 26-29 in Verona, WI.
  • Vocera will present at several investor conferences in New York City in September.
  • NHSX and NHS England name Meditech as an accredited EPR supplier.
  • Aigilx Health selects Zen Healthcare IT’s Zen Stargate gateway solution for health information exchange.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.


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Weekender 8/23/19

August 23, 2019 Weekender 1 Comment

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Weekly News Recap

  • Revenue recovery software vendor Ontario Systems is acquired by an investment firm.
  • Allscripts announces availability of Apple Health Records in its EHRs.
  • A watchdog group publishes emails detailing the involvement of the “Mar-A-Lago crowd,” including an associate of President Trump, with the VA’s contracting with Cerner.
  • EHealth Exchange announces go-live of a national, single-connection gateway service.
  • A Nature article covers the responsible use of machine learning in healthcare.
  • Several investment firms are reported to be in discussions to buy Emids Technologies.
  • Ciitizen rates hospitals on how effectively they respond to patient requests for copies of their information.
  • An OIG report finds that the VA’s overdue, over-budget scheduling project is nearly finished, just in time to be replaced by its Cerner implementation.

Best Reader Comments

[From the author of a report predicting that clinical decision support systems will replace EHRs as the primary physician interface] CDS are now mostly point solutions, but the CDS vendors are expanding their reach and are discovering something interesting: the more they expand, the more EHR data is required. At some point most of the data in an EHR is then in the CDS. We have not reached that point yet, but when that happens, it makes logical sense to invert the model, where an EHR gates most health It functionality and change it to a model where the EHR is actually subordinate to a more user friendly interface: likely one that looks a lot like a CDS … The essential notion is solid: EHRs are not user friendly, but CDS generally are. This is an unstable dynamic and we believe that someone will move to address the problem. Also, we did talk to practically every CDS vendor as well as every EHR vendor and healthcare delivery organization. The interesting thing is that the idea that CDS would take over did not come from the CDS community, but came from the healthcare delivery community. (Mike Jude)

[To the author of the report above] You make some sweeping assertions without any basis in fact. “EHRs are not user friendly, but CDS generally are” – what is this conclusion based on? You assert “CDS are often developed in response to specific pain points: new regulations, new dosing requirements, etc.” Are there any serious CDS systems certified for Meaningful Use AND in general adoption by doctors at the point of care? And on what fact base do you assert that EHR vendors don’t “incorporate human factors to ensure low impact human interactions?” (Supporting good decisions)

[Referencing an article on Apple Health Records] How will access to my EHR data help me “shop for high value health care services” and “avoid the need to repeatedly supply data for entry?” These discussions are without substantive support in any fashion that I can see. I hope my tax dollars did not pay for this. (FormerCIO)

The ACR AUC system is ridiculous for specialist physicians. I am a board certified orthopaedic surgeon who knows when I need an MRI or CT scan. At what point does the system trust me to make a decision about the care of my patients? After two MOC exams? After 20 years in practice? Am I an outlier with studies? No. So if ACR wants to do AUC, then have the radiologists do it, not me. I know what study I need and want to care for my patients. If you think you know better, then you take over the care of the patient when you deny the test. (meltoots)


Watercooler Talk Tidbits

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Millennials who document every potentially enviable aspect of their lives on Instagram are hiring professional photographers to shoot both natural and C-section childbirth, with full-time birth photographers elbowing doulas out of the way to charge up to $4,000 at trendy hospitals like Cedars-Sinai and UCLA. They leave business cards in exam rooms and with providers who hand them out. OBs aren’t always thrilled with the potential additional malpractice exposure of having everything recorded in photos or video and hospital policies are often inconsistent or non-existent.

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A dozen of Facebook’s low-paid content moderators – contracted from Accenture to review up to 800 pieces of disturbing user content such as child sexual abuse in a single shift – accuse Accenture of trying for force company-provided “wellbeing counselors” to disclose the details of their trauma sessions in what they say is a violation of HIPAA.

SimplyVitalHealth, which offers “blockchain-based solutions to emerging value-based healthcare programs,” returns $6 million to investors after the SEC charges it with conducting an unregistered securities offering in the form of an Initial Coin Offering.

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Google DeepMind co-founder Mustafa Suleyman takes indefinite leave from the artificial intelligence company.

University Medical Center of El Paso disputes President Trump’s claim that its surgeons left the OR to see him in during his post-shootings visit there, reassuring the public that in no case would that ever happen. The president said surgeons came out of ORs in both El Paso and Dayton in a spontaneous showing of “the love for me.” 

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A Miami plastic surgeon self-styled as “Dr. Slimthick” whose billboards offer Brazilian butt lifts financed at $30 per week is found to have falsified most of the credentials claimed on his website. The local paper checked his background in running a story about one of his patients, a 35-year-old woman who remains in critical condition a month after he performed her procedure. His cosmetic center is offering a silicone implants or liposuction for $3,500 if you’re in the market.

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A Texas woman faces 20 years in prison after being accused after subjecting her healthy son to 323 hospital and clinic visits and 13 major surgeries in the first eight years of his life in a case of Munchausen syndrome by proxy. She had also started several online fundraisers for the boy, claiming that he was dying from a genetic disorder and later from cancer. She had placed him on a lung transplant list and enrolled him in hospice care, caught only when employees of a Dallas hospital called child protective services. 

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Wolfson Children’s Hospital (FL) posts a video of 15-year-old Yanira Guzaman, who was able to stand for the first time and dance with her father at her quinceañera thanks to spina bifida treatments and a new power chair.


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Morning Headlines 8/23/19

August 22, 2019 Headlines No Comments

Crew Obtains New Docs on Mar-a-Lago Member’s VA Influence

Emails from VA officials obtained by a watchdog group provide greater insight into the influence President Trump’s “Mar-a-Lago crowd” had on the VA’s contract with Cerner.

Ontario Systems Announces Investment from New Mountain Capital

New Mountain Capital acquires revenue recovery software vendor Ontario Systems, which counts over 600 hospitals among its enterprise healthcare and government customers.

Apple Health Records Available for Allscripts Clients

Allscripts releases access to Apple Health Records to users of Sunrise, TouchWorks, and Professional EHRs.

Former military records technician accused of bilking millions of dollars from US soldiers and vets

The Justice Department arrests five people for stealing millions of dollars from soldiers and veterans by taking photos of their AHLTA EHR screens at an Army base in South Korea, then using that information to log in to DoD’s self-service system to steal bank account details.

News 8/23/19

August 22, 2019 News 5 Comments

Top News

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A watchdog group obtains emails from VA officials – invoking the Freedom of Information Act – as they discussed the so-called “Mar-a-Lago crowd” of non-experts who provided advice to the VA with the implied endorsement of President Trump, with much of that involving its contracting with Cerner.

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One of the emails contradicts reports that the group’s involvement was unsolicited and that then-Secretary David Shulkin, MD resented it. The VA’s acting CIO asked the group for their help as recommended by Trump associate Bruce Moskowitz, MD, a West Palm Beach internist. 

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John Windom, who heads up the VA’s EHR modernization project, said a scheduled meeting was a “grin and bear it” session, while that group’s former chief medical officer termed their questions as “ridiculous” and lacking even a basic understanding of systems and interoperability.

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Moskowitz emailed to insist that the trio be “on every call that the group is on to discuss the contract.”

One of the released emails contains a detailed list of questions that were posed to the VA in response to Cerner’s RFP in a conference call with the group, with the VA providing detail for such observations such as:

  • Any requirement of “true interoperability” would require contractual terms with both Cerner and other primary EHR vendors such as Epic, Meditech, and Allscripts. The VA said its contract only covers Cerner, but the VA is pursuing partnerships with other health system providers “to meet Cerner’s commitment to data sharing.”
  • Commenters noted Cerner’s weakness in medical imaging.
  • An observer asked why the contract doesn’t require a single Cerner instance shared between the VA and DoD.
  • One commenter said their experience with Cerner is that reports from outside providers are imported as CCD/CCA and labeled as “Outside Material” instead of within normal workflow.
  • Another worried that a lack of definition of interoperability, observing that DoD users are “rebelling” over unsuitability for their needs.
  • One comment said that Cerner has lagged in FHIR development and assigned few resources to it.
  • A reviewer worried that instead of creating a next-generation system, Cerner will “just add more unmaintainable code to the existing spaghetti bowl.”

Reader Comments

From Grahame Grieve: “Re: Apple Health Records. HIStalk responded to a reader comment in saying that healthcare ‘embraces the most proprietary technology vendor in touting Apple-only patient access.’ I would like to point out that Apple has implemented the Patient API as published in the Argonaut specification, and the same interface is used by other vendors, including AllOfUs, CareEvolution, Coral Health, Ciitizen, 1UpHealth, PatientLink, and many others. While Apple may have business advantages due to their size and significance, any other vendor is able to use the same standard interface, and they are welcome to join with open FHIR community to help them do so.” Grahame is HL7 FHIR product director. A couple of folks offered other reasons that most people can access their health records only if they are among the fewer Americans that use Apple phones instead of Android: (a) Google hasn’t added that capability to Android; (b) Apple must have worked around some Epic licensing issues; and (c) health systems may be reluctant to create and maintain access to their systems for Android.

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From Alias: “Re: Pulse Systems. Acquired by Amazing Charts, A Harris Healthcare Company, last Thursday. Announced to Amazing Charts employees this week.” Unverified. I ran this as a redacted rumor from another reader on Tuesday, waiting to hear back from my inquiry to a Harris Computer PR contact before naming names (they never did respond). Pulse Systems is (or was, if the rumor is true) owned by France-based Cegedim.

From For Closers: “Re: healthcare sales roles. After years (decades?) of reading HIStalk, I’ve seen several people show up more than once in the People section. Has anyone ever analyzed the number of retread healthcare sales roles? It seem a bunch of folks just flit from company to company to be VP of sales.” Good question, although hard to answer without of LinkedIn digging to (a) find experienced health IT sales VPs, and (b) count how many jobs they’ve had as sales VP (or the trendier chief revenue officer or chief growth officer titles). I’m also surprised at how often a CIO has been burned by a vendor’s oversold product, but then buddies up to the same salesperson who has moved on to another vendor. You might reasonably assume that a relationship history is not a plus when it involves lying and the resulting buyer’s remorse, but CIOs can be like doctors who let drug salespeople pull their strings – they can be manipulated to think that the salesperson is their trusted ally and personal friend.


HIStalk Announcements and Requests

Lorre asked me what we will do at HIMSS20 now that we don’t have HIStalkapalooza or an exhibit hall booth to deal with. I’m thinking we’ll just cruise around looking for news and rumors, although (a) Lorre could use an exhibitor’s pass if anyone has a spare; and (b) I guess our Smokin’ Doc standee will have to stay home since we don’t have a booth so passersby can take selfies, which is perfectly fine since his box is a pain to cart around. 


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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New Mountain Capital acquires revenue recovery software vendor Ontario Systems, which counts over 600 hospitals among its enterprise healthcare and government customers. NMC has also invested in healthcare companies like Ciox Health, which it acquired in 2014 back when it was known as HealthPort.


Sales

  • University of Maryland St. Joseph Medical Center will offer the Babyscripts app and remote monitoring support to expectant mothers.
  • Wentworth-Douglass Hospital (NH) will implement Epic in October through a software-sharing arrangement with parent company Partners HealthCare.

People

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RCM and analytics vendor AGS Health names Patrice Wolfe (Medicity) CEO.


Announcements and Implementations

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Allscripts releases access to Apple Health Records to users of Sunrise, TouchWorks, and Professional EHRs. Test sites include Sharp HealthCare, Erie County Medical Center, and Sarasota Memorial Health Care System.

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UCHealth affiliate Ivinson Memorial Hospital (WY) will go live on Epic this weekend.

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Appriss Health develops SMART on FHIR capabilities for its PMP Gateway integration software for state PDMPs.

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Adventist Health’s Rideout Hospital (CA) implements Cerner. The company took over management of the multi-state health system’s revenue cycle and clinical applications IT staff last year.

Einstein Medical Center (PA) keeps its Cerner Millennium go-live on schedule by migrating data from several legacy systems using the robotic process automation and integration platform of Boston Software Systems, avoiding manual entry and creating  a consistent, low-complexity process to make appointment and registration data available for go-live.


Government and Politics

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Politico reports that Genevieve Morris will run for office as a Republican in Maryland’s second congressional district. Morris spent a year as ONC’s principal deputy national coordinator and then just two months as the VA’s chief health information officer, a role she relinquished last summer after realizing that her vision for the Cerner implementation differed from that of her colleagues.


Other

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The Justice Department arrests five people for stealing millions of dollars from soldiers and veterans by taking photos of their AHLTA EHR screens at at Army base in South Korea, then using that information to log in to DoD’s self-service system, which provides access to 70 military systems with a single username and password. One of those systems stores the individual’s bank account and routing numbers to which government payments are sent, allowing the conspirators to transfer money, sign up for loans, and have VA payments made directly to them. One of the group’s “money mules” was a military dependent labeled as “GH,” who the conspirators threatened for slow payments by looking up GH’s own AHLTA record to find family members they could threaten.

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In an interview with Xconomy, John Halamka, MD weighs in on the hype surrounding AI in healthcare, noting that its usefulness will likely come from enhancing behind-the-scenes clinical workflows rather than the more headline-grabbing notion that AI will eventually replace physicians: “Machine learning is very good, but empathy and respect and active listening – that would not be the first use case I would pursue.”

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Cancer patients in Port Arthur, TX say they will pursue legal action against the Medical Center of Southeast Texas for abruptly closing a cancer center last year, a development they contend has prevented them from accessing their medical records and continuing treatment elsewhere. The center’s majority owner, Trip Chaudhury, MD, contends the center closed due to a dispute with MCST over repairs that needed to be made, while hospital representatives say the center was closed for non-payment of rent by Chaudhury and that he was (and still is) responsible for equipment maintenance and records access.


Sponsor Updates

  • Einstein Medical Center (PA) leverages software and consulting services from Boston Software Systems to migrate appointment data from its legacy systems to Cerner Millennium.
  • Elsevier Clinical Solutions, Healthfinch, Healthwise, InterSystems,  and Intelligent Medical Objects will exhibit at Epic UGM August 26-29 in Verona, WI.
  • Ensocare will exhibit at the ACMA Louisiana Chapter Annual Conference August 24 in Baton Rouge.
  • Hayes Management Consulting names David Rajfer (Athenahealth) product manager and Lizz Fuller (Athenahealth) implementation project manager.
  • Gartner includes Imat Solutions in its report on “The Current State of Clinical Data Integration Among US Healthcare Payers.”
  • ConnectiveRx will exhibit at NACDS Total Store Expo August 25-27 in Boston.
  • Redox announces that its customer base grew 33% over the first half of 2019.
  • TransformativeMed renews its Core Workflow Suite contract with VCU Health (VA), and announces it will become a strategic development partner to fast-track mobile notifications and messaging into EHR workflows.
  • As a payment facilitator, Patientco gives health systems more flexibility to address patient payment needs.
  • A new report from Surescripts covers the ways in which the Surescripts Network Alliance has helped improve e-prescription accuracy by 64% over the last three years.

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EPtalk by Dr. Jayne 8/22/19

August 22, 2019 Dr. Jayne No Comments

Time is ticking for practices that haven’t completed the full transition to the new Medicare Beneficiary Identifier numbers. Claims submitted with the previous numbers will be rejected starting January 1, 2020. At this point, the new MBI is only being used for 77% of Medicare fee-for-service claims. Given the duration of the transition period, I’m surprised to hear that nearly a quarter of claims are still going out under the old numbers.

Telehealth is of interest to many young active patients, but clinicians are concerned about how well it might work for older patients for whom technology might be a challenge. A recent research letter details findings on video visits that were used with homebound geriatric patients. Physicians in New York state piloted the program from June to December 2018 as they sought to identify cost-effective ways to care for older adults. The authors labeled the program as “not yet ready for prime time” even though most patients and medical social workers involved in the study felt that when a video visit was successful, it met their needs and was preferred over long wait times for in-person visits. The difficulty apparently stems from inability to successfully complete the visits, with only a 49% completion rate. Installation of the telehealth app was performed by researchers after patients were identified from a pool of enrollees in a home-based primary care program.

Of 500 eligible patients, only 56 were enrolled. Patients were assessed to ensure they were cognitively and technologically capable of conducting a visit and that there was a family caregiver willing to participate as well. Even with those controls, there were a number of technical and equipment compatibility issues, with only 39 patients completing at least one video visit with their medical social worker. The average visit length was 18 minutes. The average patient was 85 years old and issues cited included failure to remember their Apple ID or passwords. Another issue involved two-factor authentication, where patients had to receive a code to access the app before they could enter the video conference.

There are significant shortages for home-based primary care for the frail elderly who want to remain in their homes. I’d argue that even with the challenges, if we could manage a percentage of patients via video, that might be better than the current state of affairs. Using technology that doesn’t require an Apple ID (especially since Apple is no longer the darling many people once thought it was) and relaxing the need for two-factor authentication might increase the percentage of successful visits. The authors next plan to pilot a device that connects via a patient’s home television and allows use of a TV remote, which might be a better option for the target population.

There are so many publications from CMS and other governmental entities that I occasionally miss something interesting. Apparently deep within the interoperability proposed rule is a provision that requires hospitals to inform primary care physicians about patient admissions, transfers, and discharges. Although Accountable Care Organizations want access to the data, hospitals are pushing back. One stumbling point is the need to inform physicians of these activities electronically.

Another is the requirement of this notification as a condition of Medicare participation for the hospital. It also would require hospitals to determine which physician might be the most appropriate to notify. I’ve worked with the attribution issue for several of my clients and it’s never straightforward, especially when patients might have recently changed primary care physicians or when they might be admitted for a problem that is primarily under the care of a subspecialist. Patients and patient advocates are also wading into the discussion, claiming that notifying physicians without express patient consent is a violation of privacy. The comment period on this particular proposed rule closed in May, so we’ll have to see what changes might be made.

For those of us who closely monitor Medicare spending, not only professionally but personally (hoping there will still be some money available when we get to the magic age), take a look at this piece on wasteful drug spending. One of the tricks commonly used by pharmaceutical manufacturers to extend their revenue streams is the creation of drugs that are nearly identical to existing drugs, but that are different enough to have their own patent. A recent study looked at spending on these drugs and found that Medicare could have saved nearly $17 billion from 2011-2017 by substituting 12 older drugs for the newer agents. There is little clinical evidence that these newer drugs deliver better outcomes than their older generic precursors. Researchers used the Drugs@FDA database to identify drugs that had been approved and analyzed both Medicare and patient out-of-pocket spending on the drugs. The out of pocket spending by patients could have been reduced by $1.1 billion on top of the Medicare savings.

Healthcare IT could be positioned to help educate prescribers and patients about this issue through a variety of strategies. One might be displaying relative cost at the point of prescribing. Another might be showing therapeutic equivalents as a part of clinical decision support. Payers are already trying to stem the tide by putting the higher-priced drugs on higher formulary tiers, which are easily identified in some EHRs. I wonder if the development of some of this functionality in current EHRs is being stymied by the vendors’ engagement with pharmaceutical companies, since several are selling patient data behind the scenes.

Another option would be to use clinical decision support to prompt lifestyle interventions before prescribing some of the drugs and enrolling patients in care management programs to ensure they can be successful with lifestyle change. Those are more high-touch options that are less popular in our US culture, however. It’s easier to take a pill and many patients find taking the latest and greatest drug to be desirable regardless of the cost.

Mr. H scooped me with his report on the Patient Record Scorecard, which grades hospitals on how effectively they respond to records requests from their patients. I had heard about it in a different context, when a reader clued me in to a site called MedRxiv (prounced “med archive”) which describes itself as “The Preprint Server for Health Sciences.” Essentially, the site is publishing manuscripts that are preliminary in nature and haven’t yet been through a peer review process. The site was founded by non-profit Cold Spring Harbor Laboratory, Yale University, and BMJ and operates as “a platform for researchers to share, comment, and receive feedback on their work prior to journal publication.” I hope the authors of the Scorecard can ultimately get their findings published since they seem consistent with what many of us are experiencing.

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Morning Headlines 8/22/19

August 21, 2019 Headlines No Comments

HHS Awards $107 Million to Support Health Center Quality Improvement

HHS awards $107 million in Quality Improvement Awards to 1,273 health centers across the country that have, among other improvements, advanced the use of health IT.

Mobile EKG maker AliveCor has cut ties with Apple amid rising tensions over wearable EKGs

AliveCor takes its Apple Watch-compatible KardiaBand off the market to focus more on expanding the capabilities of its KardiaMobile EKG products.

Fitbit wins contract with Singapore to supply trackers to potentially hundreds of thousands of citizens

Fitbit edges out Apple in a contract win that will see the wearables company provide devices to Singaporeans who enroll in the country’s Live Healthy SG program.

VA scheduling tool enhancement ‘almost complete,’ just in time to be replaced

A report from the Department of Veterans Affairs Inspector General finds that enhancements to the VA’s scheduling software are four years overdue, over budget, and soon to be replaced by capabilities within the department’s new Cerner EHR.

HIStalk Interviews Steven Davidson, MD, Retired CMIO

August 21, 2019 Interviews No Comments

Steve Davidson, MD, MBA is retired as an emergency physician and CMIO of Maimonides Medical Center in Brooklyn, NY and provides consulting services as EMedConcepts.

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Tell me about yourself.

I was born in Philadelphia. My dad was an internist-gastroenterologist, doing endoscopies back in the era of rigid scopes. My grandfathers were home carpenters, so I grew up with the idea that you could use your brain and you could use your hands. I went to medical school because I had ambitions to be an academic. I discovered emergency medicine as a new field. I was impressed by David Wagner, who was one of the grandfathers of the field. He was a pediatric surgeon who worked in the ER so he could pay his kids’ tuition.

Since it was a new field and there were fewer people clambering around on the ladder, I thought I might get to the top quicker. I never really made it to the top, but did OK. As one of the earliest trainees, I got involved in academic emergency medicine and was a tenured full professor. I went to Wharton, got an MBA, and managed to land a really nifty job in Brooklyn, working for a guy who was doing a turnaround on a hospital there, Maimonides Medical Center. 

He let me take the ER as an independent business unit. I ran the medical side and the business side of the ER. Everybody who worked in the ER worked for me, including nursing. If there were more than five people in a job title, they worked for me. I did that for 15 years, managed to piss off a few people, and got kicked upstairs to the CMIO gig. I discovered that my impatience and short attention span, which was an asset in the ER, was a contributor to a crash landing in the executive suite.

I went back to taking care of patients for a few years, sold my place in Brooklyn at the top of the market, and came back to Philly, where I had real connections beyond professional friends. I’ve spent the last 16 months renovating an old stone pile, a 100-year-old house, and working on Steve — going to the gym, eating right. I’ve gone to hear lots of live music. That’s enough.

Now that you’re somewhat of an outside observer of healthcare, what do you see?

If you’ve seen one ER, you’ve seen one ER. They are all different. I brought to that my experience with W. Edwards Deming and the idea of improvement processes, things like that.

Culture is an overwhelming force that is hard to overcome, and healthcare’s culture has been incredibly physician-centric. The nursing force was always there, but has gotten much stronger with the real administrative control that has gotten much, much stronger. It’s hard to see how, other than in small-scale improvement efforts, overall system improvement is going to happen without major legislative and financial flow change.

Your work in the ED was the ultimate episodic practice. Is it a marketing challenge to convince patients / consumers why they should value continuity of care when they are reasonably happy with the status quo other than price?

Middle-class folks who can afford the drop-in to the urgent care centers are eager to scratch that itch right away. In my experience in caring for the people who were not regularly doctored – for example, the folks who were on medical assistance in Brooklyn and had to make do with hospital clinics — would get very dejected when the internal medicine resident who had clinic once a week graduated after three years and was no longer their doctor.

I can’t tell you how many people I saw over my 15 years in the ER who would show up after not having been in the ER very much in the previous several years. They had been assigned to a new doc and clinic and they didn’t like that doc. Those people craved the continuity of care. My middle-class friends on Facebook, to all appearances, are glad for the networks of urgent care centers.

How should we apply social determinants of health to improve public health?

Many ERs, including where I used to work, have identified lists of frequent flyers. This goes back to the work of a guy at Cooper in Camden that was written up in the New Yorker, it might be 10 years ago now. He identified people who needed a new refrigerator, a new bed, or their roof repaired. Social determinants of health.

What’s happening in a place like Maimonides Medical Center is that the patients who were constantly in the emergency department, they are trying to get at the contributors to these visits. They get social work and community organizations engaged. At Maimonides – I’m not hawking what they’re doing as anything special because I know other places are doing it, I’m just telling you about the place where I know a little something — put together this community health network. They have integrated behavioral health with primary care for this patient population, for the broader group of patients with any serious behavioral health issues. It’s apparently having some impact on the frequency of utilization of the emergency department by individuals identified within this population.

As someone who ran medical services for a big-city fire department, how well have we integrated 911 services, pre-hospital care, and related technology into hospital practices?

There was a time when EMS developed as a medical service. If you go way back, ambulances were a secondary function of hearses. If you move a little bit past that, Frank Pantridge created heart ambulances in Belfast, Northern Ireland to save “hearts too good to die” with a defibrillator. Trauma surgeon David Boyd recognized that trauma care in Vietnam was better than it was for a motor vehicle crash victims.

Pre-hospital care developed as a medical service. Over the years, fire departments increasingly engaged it, initially for their own purposes to provide services to their own people who got injured at scenes. Over the years, as the number of structure fires began diminishing — both because older structures had burned out and because of better fire prevention practices — fire chiefs needed to maintain a reason for a handle on the public purse. Since they already had ambulance services for their own folks, they increasingly moved into EMS. Ultimately, what we’ve decided as a country by and large is that EMS pre-hospital care mostly resides in paid fire departments, at least in the urban and inner suburban areas.

Even as that was happening, Joe Ryan in Pinellas, Florida and others like him identified that a large number of people were calling for care. They were worried well or had something small and self-limiting that could be dealt with on the scene. In Brooklyn’s Orthodox Jewish community, you have Hatzolah, an all-male volunteer ambulance service that raises funds, does not bill, and hence has no requirement to transport. Without transport in EMS, nobody pays. You get paid for the transport, not for the care. Hatzolah is an example of doing this right within the community — responding to people’s needs, offering help at their bedside or in their home or workplace, and not necessarily transporting.

Emergency medical dispatch, created by Jeff Clawson, MD, is a discipline that has developed data-driven protocols to give telephone advice prior to arrival and to help select the requirements for urgency of response. The fire departments are overwhelmed and budgets everywhere are under such stress that they are interested in interventions that avoid transport and divert callers / patients into other means of care. That’s probably a good thing if it’s being done correctly. Joe Ryan, who now is in Reno, got money from CMS several years ago to look at an expanded role for paramedics to offer care in the community. I don’t know whether he was able to move forward with that based on issues with the local ambulance providers.

Doctors and nurses, by and large, have a charitable and helping impulse. With the public safety mindset — firefighters among them, who are rightly celebrated for running into the danger when everybody else is running away — there remains some question in my mind as to how suited the fire department is to be doing this work. But clearly fire chief leadership across the country has taken up this role throughout and is doing the best they can with it.

Jim Page was a fire chief, founder of the Journal of Emergency Medical Services, and a big booster of EMS on the fire side in California. Mr. Page has been dead for a decade or so, but there was a point at which he quite publicly said that doctors in EMS were bossy nuisances. To some degree, that’s part of the environment I worked in and why I decided to move on from the EMS leadership roles I’d had.

We first exchanged emails about the extent of misdiagnosis and how machine learning and artificial intelligence might have a role. As a doctor, how much value would you receive from technology helping you arrive at a diagnosis?

In the dim, dark past, I was a clinician working with John Clark, a surgeon. He was able to show that a junior resident using his software solution, running on an old Mac, was more accurate in diagnosing appendicitis than the most experienced surgeons by themselves. There was a period of time where John’s software was used on the orbiting space station. That was before we did a lot of bedside ultrasound and CT scanning of the abdomen. I’m telling you this story just to preface my response that in medicine, certainly emergency medicine, we are learning about our cognitive errors in reaching decisions for patients, including diagnostic decisions.

The heuristic is that you know what you know, and if you don’t think of something, it doesn’t end up on your differential diagnosis. If it’s not something you see very often, you may not think of it. Systematic ways of prompting consideration of reasonable possibilities — and who the hell knows what “reasonable” is? —  can be of value.

I just saw a paper pointing to the three areas of most diagnostic error harm – vascular events, infections, and cancer. These are big categories, even in the emergency department. Patients have cancer that hasn’t yet been diagnosed or they’ve had previously diagnosed and treated cancers and present with a new set of symptoms. It’s easy to think in terms of the statistical probabilities rather than considering the possibility of other cancer stuff.

What advice would you offer to someone looking forward to retiring and not having to go to work every day?

I’m no great fan of Arthur Brooks, who just announced that he’s retiring as executive director of the American Enterprise Institute, but he had a spectacular essay in the Atlantic called “Your Professional Decline Is Coming (Much) Sooner Than You Think.” It basically says that you are already past the peak of your career. You just don’t know it.

He writes very broadly in terms of how you might think of the rest of your life. I have found it thought-provoking and well worth the read. For me, I am a reader. I am a curious person. I’m a big-time lover of acoustic music – bluegrass, old-timey Irish music, and all the mash-ups of that.

You must be more than your career. I’m extraordinarily fortunate that my folks introduced me to music while I was young. They didn’t give me a hard time when they found me reading the Encyclopedia Britannica under the bedclothes by flashlight in the middle of the night.

People are where it’s at. The residency that I was part of at Hahnemann Hospital is gone and the hospital is closing down. Before that, Medical College of Pennsylvania, where I spent 20 years. That’s gone, absorbed into Drexel. Places disappear, places change.

I’ll just close with one last thing. A man very close to me — we’ve been friends since we were 18 — had a terrible fall last week. He was horribly injured and is in an ICU of a big trauma center. I got to his bedside about 20 hours after he got to the hospital, but I got help by reaching out to the broader emergency medicine community. I was connected to the doctor who first cared for him when he hit the ER. That doctor was two degrees of separation from me, and I was connected to that doctor within about two to three hours of calling out for help to my network.

It’s people, it’s people, it’s people. Whatever you do in retirement, stay connected to people.

Morning Headlines 8/21/19

August 20, 2019 Headlines No Comments

Veterans Health Administration, AdventHealth, OCHIN, & InterCommunity CCO Pioneer New eHealth Exchange Health Information Network Infrastructure

EHealth Exchange announces go-live of a national, single-connection, InterSystems-powered gateway service whose charter members include the VA, AdventHealth, InterCommunity CCO, and OCHIN.

Health2047 Spins Out Zing Health to Improve Health Outcomes for Underserved Populations

AMA-backed Health2047 launches Zing Health to offer community-focused and analytics-driven Medicare Advantage plans that take into account social determinants of health.

Hospital website hijacked by ‘pirates’

The URL of Sonoma Valley Hospital (CA) is “maliciously acquired,” forcing the hospital to change its prized three-letter domain name of “svh.com” to “sonomavalleyhospital.org.”

New Tampa General Hospital center uses human and artificial intelligence to improve patient care

Tampa General Hospital (FL) joins the “Mission Control” club with the launch of CareComm, an 8,000 square-foot center the hospital will use to coordinate patient care using AI and predictive analytics.

Healthcare Embracing New Era of Compliance and Analytics

Healthcare analytics company Protenus raises $17 million in a Series C funding round led by LTP.

News 8/21/19

August 20, 2019 News 6 Comments

Top News

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Nature magazine has run some good healthcare related articles lately (they are always called to my attention via tweets from Eric Topol). A new perspective piece covers the responsible use of machine learning in healthcare, containing many points that are likely new to the healthcare-inexperienced technologists who might be searching for any protruding nail for their proudly-created hammer:

  • Choose the right problem, not just one for which a convenient ML training database exists. You can predict in-hospital mortality from a wealth of data, but does it tell clinicians something they don’t already know? Will the right people be involved in considering the actions that will be taken in response?
  • Make sure the data elements are appropriate. ICD-10 codes entered after the patient’s encounter won’t be available when they are needed. They may also be driven by billing requirements rather than clinical ones.
  • Account for inconsistent data collection practices across departments and health systems.
  • Make sure that training data represents all populations.
  • Watch for potential bias, such as creating an algorithm of whether a patient should have surgery based on those patients who actually did, who are probably more affluent than those who didn’t. Or in cases of a system that can infer information that the patient declined to provide, such as smoking or HIV status, which may cross ethical boundaries.
  • Avoid “label leakage” in model testing, such as randomly assigning X-rays between training and testing sets without recognizing that patients have multiple images, which would then overweight the model’s accuracy.
  • Break out the model’s testing results into the specific areas where it either excels or fails. Potential users need to know what a particular model works well in adults but not pediatrics, for example.
  • Use clinically relevant evaluation metrics that look at the positive predictive value and sensitivity. A model whose high false-positive rate predicts a situation that requires high-cost, limited-value drug therapy isn’t going to be useful.
  • Publish results with restraint, sharing code, data sets, and documentation so that other researchers can make their own assessments of usefulness.
  • Test the system on real-life patients in silent mode only, where clinicians review the predictions without acting on them. Then move on to randomized controlled trials while recognizing that randomization at the patient or physician level is difficult and could endanger patients.

Reader Comments

From Mo Exposure CEO: “Re: links. Thanks for linking to our company’s news item. The response from HIStalk readers was amazing.” Thanks for deciding to sponsor the site as a result, especially since I don’t run fluff news pieces, meaning your announcement had to earn its way into my news post. Items I mention sometimes get a lot of clicks. Even webinar announcements sometimes get a couple of thousand clicks, and announcing a new sponsor always draws several hundred. Sponsor support comes from having loyal, influential readers, so my only job and outcomes measure is to make it worth their while to return.

From She Lives on Love Street: “Re: [RCM business line omitted.] Word on the street is that it’s been sold to [acquirer name omitted].” I’ve emailed the rumored acquirer’s PR contract but haven’t heard back. I’m running the redacted version to remind myself to follow up.

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From Core Cutter: “Re: Apple. This CNBC article suggests internal trouble with its health offerings.” Reporter Chrissy Farr sometimes writes good health IT-related stories, but this isn’t one of them. I suspect her editors are pushing her too hard into drumming up questionably researched, speculation-based stories that hold minimal news value, as in her never-ending quest to take guesses at “what Amazon is doing in healthcare” because naming those big names draws eyeballs, but leave their owners with little useful information. This one tries to extrapolate Apple’s health-related departures into “differing visions for the future” that aren’t backed up by the stated facts. My take:

  • She interviewed “eight people familiar with the situation,” none of whom are the people whose departures she noted, and those people she spoke to are simply speculating on why those people left.
  • The five folks listed as having departed held wildly unrelated Apple “health” jobs, ranging from marketing to wellness clinic executives. It’s not like a mass exodus, either in numbers or in area of focus.
  • The denominator of health-related jobs at Apple isn’t given, so we only know that it’s five positions out of hundreds.
  • The story reports from the unnamed sources a difference of opinion among health-related employees about Apple’s direction, but those weren’t tied directly to the departures and those former employees didn’t say that’s why they were moving on.
  • The clickbaity, present-tense headline implies a sudden uptick in internal tension, but does little to back that up with facts.
  • We don’t have anything to suggest that Apple is disappointed in its health-related results or that it would like to change direction.
  • Health and health IT have always had high turnover, some of it based on unreasonable expectations or finding out that big companies just want to make money instead of making people healthier, but in Apple’s case there’s also the possibility of parlaying an Apple credential into an even better job.
  • Even if the story is right in claiming internal tension, so what? You’ll know if Apple makes major product or organizational changes. Speculating beforehand may be entertaining doesn’t really add value, except for the sites trying to sound insightful.

HIStalk Announcements and Requests

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I Google-discovered Zenni in helping a friend get eyeglasses and it’s pretty cool. You key in the vision numbers from your eye doctor’s prescription (they don’t want the actual prescription), use a ruler to measure the distance between your pupils, and then head off through a long list of frames to choose your glasses. It takes a couple of weeks to received them in the mail from China and then you’re set unless you need to bend them a bit like your optician does for a perfect fit (not necessary in his case). The biggest draw beyond convenience is price – a pair of snazzy progressive glasses cost him less than $50 (they look exactly like his $300+ pair from Costco), single-vision sports glasses with polarized lenses were $60, and no-nonsense single-vision sunglasses were $15 (!!). At these prices, you could stash a pair of prescription sunglasses in every car, get some glasses set for computer monitor distance, and get backup normal glasses for next to nothing.  What you end up with is pretty much exactly what the optician would sell you for five times the price after two trips to the store. You still need an eye exam every year or two, but what happens afterward is Zenni’s strong suit. You could do a life-changing but inexpensive good deed by treating someone who can’t afford glasses to a pair of Zennis.

Color me skeptical: a new Frost & Sullivan white paper (which you can download only if you provide work details) predicts that clinical decision support systems “are poised to become the user interface of choice for clinical interaction with health IT,” replacing the EHR. My take is exactly opposite – clinical decision support systems will feed their information and recommendations through the EHR, disappearing in the background but providing no less of a service in recognizing that clinicians rightfully want everything placed into their EHR workflow and design. Nobody in their right mind would suggest that CDSS systems contain everything a clinician needs to see, or to visualize how those systems would interact with the user when several are in use (one for radiology image appropriateness, one for antibiotic stewardship, etc.) I think F&S is way off base here, and had I cared enough to download the report, I bet I would find some CDSS vendor involvement. The HIMSS rag gave it a dramatic headline, a pointless stock art photo, and a non-critical acceptance of what the report’s author said, assuming they paraphrased it accurately. This is one of those reports that predicts huge growth in some market segment, knowing that a more realistic report wouldn’t exactly fly off the shelf.


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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The newly hired, cost-cutting CEO of India’s second-largest hospital chain will slash its expenses by 20% in trying to recover from the misappropriation of company funds by its previous owners. Publicly traded Fortis Healthcare will reduce doctor pay, replace people with software, close underperforming hospitals, sell non-essential assets, and ensure that nurses perform only those tasks that lower-paid employees can’t do.

EHealth Exchange announces go-live of a national, single-connection, InterSystems-powered gateway service whose charter members include the VA, AdventHealth, InterCommunity CCO, and OCHIN.


Sales

  • Vanderbilt Health chooses Sectra for PACS and VNA in diagnostic radiology and cardiology.
  • Medical records retrieval vendor Womba chooses Allscripts Veradigm EChart Courier to aggregate provider patient records to its attorney clients.

People

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Spok hires Matt Mesnik, MD (Vigilant Diagnostics) as chief medical officer.

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Josh Hoders, MBA (DrFirst) joins Forward Health Group as sales VP.

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FDA hires Vid Desai (Vyaire Medical) as CTO.


Announcements and Implementations

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A KLAS review of drug diversion monitoring technology finds that Omnicell Analytics is the most widely adopted solution, but many customers fail to achieve their expected outcomes because they decline to pay the extra cost of EHR integration.Medacist RxAuditor has a lot of customers, but outdated technology and workflows cause most of them to use only its simplest dispensing reports in then chasing down problems via manual workflows. Kit Check’s Bluesight for Controlled Substances holds promise based on early adopter reports.


Other

The URL of Sonoma Valley Hospital (CA) is “maliciously acquired,” forcing the hospital to change its prized three-letter domain name of “svh.com” to “sonomavalleyhospital.org.” The hospital’s URL registration was good through late 2021, but someone updated it using credentials from an unknown source to take control, which an expert contacted by the local paper says is nearly impossible to reverse. I checked the Whois for the URL and it’s now running on China-based servers with “registrar lock” turned on. I thought it was straightforward to contact the web registrar or ICANN with proof of ownership to get the transfer reversed, but regardless, hospitals should:

  • Use complex passwords for their domain service’s website.
  • Change the registration address if it points to the same domain since otherwise you’ll lose the ability to be contacted if someone grabs that URL.
  • Turn on the “registrar lock” option of your domain service so it can’t be transferred.

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A fired VA hospital chief pathologist is charged with three counts of involuntary manslaughter after a review of his needle biopsy cases showed a misdiagnosis rate of 10%, 10 times the expected rate. The VA says he was responsible for at least 15 deaths and an unknown number of incorrect diagnoses. Colleagues had complained of his erratic behavior for years, but the VA let him continue working while he underwent drug and alcohol rehab, finally firing him in 2018 after a DUI arrest.

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Kaiser Health News covers the plight of several “no-stoplight” rural towns that believed Miami entrepreneur Jorge Perez, who promised to save their tiny local hospitals but instead used them in a massive insurance fraud scheme that took advantage of higher lab billing rates for rural hospitals. A 14-bed hospital cranked out bills for $120 million in just six months, of which $80 million went to the hospital’s new owner and little to the hospital, as employees reported running out food, cleaning supplies, and IV fluids, with patients in one of them displaced because their hospital beds were repossessed while they were still occupying them. When insurers eventually stopped paying, 12 of the hospitals filed bankruptcy and eight closed. Perez paid $3.5 million to settle the the DoJ’s false claims charges and says he’ll now focus on his software businesses.


Sponsor Updates

  • Hackensack Meridian Health Jersey Shore University Medical Center reduces stroke-related readmissions by 50% after implementing Vocera Care Inform to provide personalized audio discharge instructions and educational materials.
  • Healthfinch announces several new customers of its Epic-integrated Charlie Practice Automation Platform and its exhibit at Epic’s UGM next week.
  • Aprima will host its 2019 User Conference August 23-25 in Grapevine, TX.
  • Artifact Health publishes a new case study describing how its mobile physician query tool helps Western Maryland Health System accurately code episodes of care in a quality-based reimbursement program.
  • Burwood Group is raising money for the Boys & Girls Club of Greater San Diego.
  • Wolters Kluwer Health releases six new Audio Digest Topical Collections for CME.
  • CoverMyMeds and Culbert Healthcare Solutions will exhibit at Epic’s UGM August 26-29 in Verona, WI.

Blog Posts


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Contacts

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Get HIStalk updates. Send news or rumors.
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Morning Headlines 8/20/19

August 19, 2019 Headlines No Comments

US healthcare BPO may be valued at $225 million: PE firms in race to acquire emids Technologies

Several investment firms, including Everstone Capital and ChrysCapital Advisors, are in talks to buy Nashville-based health IT vendor Emids Technologies for between $200 million and $225 million.

athenahealth Appoints Simon Mouyal as Chief Marketing Officer

Simon Mouyal (Medidata Solutions) joins Athenahealth as chief marketing officer.

Two Chairs raises $21M to continue to build out its mental health clinics

Mental healthcare company Two Chairs will use a $21 million Series B funding round to expand its clinic footprint in California, and improve and expand upon its patient/provider matching technology.

Curbside Consult with Dr. Jayne 8/19/19

August 19, 2019 Dr. Jayne 1 Comment

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I wrote back in 2017 about the All of Us research program, sponsored by the National Institutes of Health. Originally they were trying to build a cohort of 1 million patients to help them look at genomic, clinical, and lifestyle data over a 10-year period. The New England Journal of Medicine recently published an update on the program’s progress.

Following the original beta program that I wrote about, All of Us opened for general enrollment in May 2018. Elements of the program include health questionnaires, EHR data, physical measurements, and the collection of biospecimens.

As of last month, more than 175,000 participants had contributed biospecimens, with more than 80% of those participants being from “groups that have been historically underrepresented in biomedical research. That’s a pretty big deal, since it’s difficult to recruit research subjects from certain subsets of our population. They’ve also collected EHR data on more than 112,000 participants from 34 recruitment sites. Should the researchers meet their goals, the robust nature of the data would allow researchers to explore factors related to individual lifestyle differences, socioeconomic factors, environment, and biology in order to better understand how we can prevent, diagnose, and treat diseases.

Having historically underrepresented patients join the program is great since those populations often have inadequate access to healthcare. Although some conditions can be linked to race and ethnicity, they’re only pieces of the puzzle. Other factors influencing health include age, sex, gender identity, sexual orientation, disability status, access to healthcare resources, income, educational level, ZIP code, and more. Researchers are prioritizing those underrepresented populations for physical measurements and biospecimen collection.

Unlike other data-gathering programs, All of Us doesn’t focus on any particular set of diseases like cardiovascular conditions or cancers. It seeks to create a broad data set that can be used for a variety of investigations, including outcomes research. Although they’re currently only enrolling adults with the ability to participate in an informed consent process, they’re looking at protocols for enrolling minors as well as adults who might be cognitively impaired. The materials are only available in English and Spanish, so it’s not a true cross section of the population, but the program is moving in the right direction.

The program has launched a web-based data browser where you can search concepts for some of the conditions and statuses being tracked. Although patients can only see their biometrics and survey responses, the researchers are working to build protocols to share genetic, laboratory, and EHR data back to participants. Priority will be given for actionable genetic information and pharmacogenetic results, delivered to those patients who have elected to receive that information.

Since the database is intended to be longitudinal, it will be interesting to see how many patients continue to participate over time. Since its inception, Congress has allocated $1.02 billion to the program, including funding for genome sequencing and setup of genetic counseling resources for participants receiving actionable results. The 21st Century Cures Act authorized funding through 2026 in the amount of $1.14 billion.

Another element that they’re still trying to work out is the incorporation of wearables data. Patients can share data gathered from Fitbit devices and investigators are looking at collection of data from other sources. Given the number and diversity of devices out there, they would need to support quite a few platforms to be able to get a good sampling. My extended family’s affinity for devices ranges from Garmin to Fitbit to Apple. Even with concerns about the validity of data from wearables, it’s interesting to note that simply having a wearable health tracker of any kind says something about a patient’s socioeconomic status and awareness of health issues.

One of the challenges noted by the authors is the incomplete nature of some of the EHR data, along with variability in that data. They are working to harmonize the data that they bring in from EHRs at recruiting institutions and are discussing ways to incorporate data from patients receiving care in rural settings. Health Information Exchanges might be another data source for those patients.

A quick tour through the online data browser illustrates some of the challenges of managing the data. The concept of diabetes can be rendered as the presence of disease, as a factor leading to adjustment of other lab values, and as a status identifier. There are also issues with EHR data in that it’s not always going to be complete enough to have the statistical power that you might find with data collected as part of a prospective trial. Still, it’s better than some of the current options, and I’m eager to see how things develop.

The biggest challenge they’ll have to face, however, is recruiting the more than 800,000 patients they still need to create their target population. It’s likely that in the early days of the program enthusiasm and awareness were high, resulting in the enrollments they already have. They’re going to have to stay on pace at the recruiting centers they already have up and running or dramatically expand the number of locations that can assist in the recruiting process.

Another option is to expand what they call direct volunteers, which are patients who come to the program from outside the designated recruiting centers. Reaching those folks who might be in rural areas or who just don’t come into care and are therefore less likely to be recruited requires different kinds of efforts. I haven’t personally heard anything about the program except from healthcare IT sources, and I’m constantly in and out of medical centers across the country. I’ve seen more signage about Ebola virus than I’ve seen about the program.

Given the size and breadth of our reader base, I’m hoping someone has first-hand experience with All of Us, either as a researcher or as part of one of the recruiting institutions. What has your experience been? How enthusiastic is the team? What can the rest of the healthcare community to do help you meet that million patient goal? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 8/19/19

August 18, 2019 Headlines No Comments

Starboard Value shrinks stake in Cerner

Activist investor Starboard Value, which scared Cerner into giving it board seats in a “cooperation agreement” in April 2019, has sold CERN shares as the price moves up.

Cape Cod Healthcare to build $180M patient tower on Hyannis Harbor

Cape Cod Healthcare will build a $180 million patient tower in Hyannis and will implement Epic.

The Patient Record Scorecard: What is it and Why we did it.

Consumer health data platform vendor Ciitizen rates hospitals on how well they respond to patient requests for copies of their own information.

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